Provider Demographics
NPI:1336244524
Name:MONSERRATE COSTA, SALOMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALOMON
Middle Name:A
Last Name:MONSERRATE COSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539A CALLE S CUEVAS BUSTAMANTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2681
Mailing Address - Country:US
Mailing Address - Phone:787-765-0054
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:539A CALLE S CUEVAS BUSTAMANTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2681
Practice Address - Country:US
Practice Address - Phone:787-765-0054
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026106AMedicare ID - Type Unspecified